Engaging Clinicians In Clinical Content

Engaging clinicians in clinical content: Herding Cats Or Piece Of Cake?
Heather Leslie, Sebastian Garde, Sam Heard, & Ian McNicoll

‘Herding Cats’OR‘Piece of cake’
Premise: Herding cats is hard
[Search for ‘Herding Cats’ on YouTube!]

‘Herding Cats’OR‘Piece of cake’
pieceofcake
One slice of cake.
(idiomatic) A job, task or other activity that is easy or simple to do.
“Sure, no problem. It'll be a piece of cake.”
© Ocean Informatics 2009

Clinicians & EHR Content
Should clinicians be involved in the development of clinical content?
Universally the response is generally ‘Yes’
So, why is it hard for grassroots clinicians to get involved?
Processes
Content Models

What are the barriers?
Processes
Content Models
Traditional software development is driven by technical requirements
Standards organisations are not easy to get involved
Technical focus
Jargon
$$$ & Time
Technically driven
Not usually human friendly

Litmus Test: Involving clinicians
Processes
Content Models
Is it easy for grassroots clinicians to get involved and contribute?
Can grassroots clinicians make sense of the clinical content?

What is reasonable and realistic?
Should Clinicians have to change?
Become technically competent so that they can engage with technicians, informaticians, vendors and standards organisations
OR
Should the Health IT domain change?
Create opportunities and mechanisms to harness clinician contributions, whatever their ability or availability

Clinicians should be driving the EHR content development...
...IT is the delivery tool

Opportunities...
Processes
Modify the EHR development approach
clinical & technical
Educate clinicians
Jargon, Reference Models etc
Enable clinicians to participate
Accept any/all contributions
At times/methods convenient to clinician
Minimise disruption to their clinical practice
Content Models
Make the models more human-friendly

What is openEHR?
The openEHR Foundation is a non-profit established in 2001
= open source specifications for a logical EHR architecture
Community >1500 people from >85 countries
Purpose: Semantic interoperability of healthdata

openEHR approach
Separation of technical and clinical content domains

Clinical Knowledge
Domain
ARCHETYPES
TechnicalDomain

openEHR approach
Separation of technical and clinical content domains
Clinical content models
Archetypes
= computable definition of clinical concept
Maximal dataset for universal usecase
eg Blood Pressure, Diagnosis, Family History
Formats/Views:
Structured definition – Design & Review
Mindmap - Review
Technical specification - ADL
Templates
= aggregations for archetypes for a clinical scenario eg Antenatal visit or Discharge Summary

Archetype Editor:
3 open source tools
Archetype Authoring:
Clinician input is critical
Training: 2-3 days intensive plus ongoing mentoring
Level of Difficulty: MODERATE
Who? EXPERTS (if aiming for
high level semantic interoperability)

Template Editor:
1 commercial tool
Template Design:
Reflect requirements of real-life clinical scenario; Should be authored by clinicians with direct knowledge of clinical needs
Training: 0.5-1 day
Level of Difficulty: EASY
Who? ANYONE

Terminology Subsetting Tool:
1 commercial tool (linking directly to archetypes/templates)
Subset design:
Clinical input is critical
Specialised training in SNOMED required – 3-5 days
Level of Difficulty: HARD
Who? EXPERTS

Clinical Knowledge Manager
= international library/repository
www.openehr.org/knowledge
Launched in April, 2009
CLINICAL COLLABORATION – Health 2.0 approach
Archetype Publishing & Governance
Translations; Terminology binding
Next steps: Templates, Subsets, ‘Sandpit’
Federation of repositories
Level of Difficulty: EASY
Who? ANYONE

View 1. Structured Definition

View 2. Mindmap view

View 3. Archetype Definition Language

Blood Pressure archetype PUBLISHED: 31 clinicians and informaticians from 13 countries
8 review rounds of 2 weeks each
Is this perfect?
NO but it is an agreed representation of
current clinical practice...
What have we achieved?
Consensus view of range of clinicians, different geographical locations, range of domains
Pragmatic starting point, can evolve

Reviewers can comment on each archetype one data element at a time.
Editor facilitates the accumulated comments and consolidates the changes in the archetype.
Then initiates the next review round ...

How many archetypes will we need?
~50 archetypes will model core clinical content
~1500-2000 will model the majority of EHR
ONLY 10 agreed archetypes to ‘save a life’

Conclusion:‘HerdingCats’OR‘Piece of cake’
Archetypes are EHR content models specifically designed for use by clinicians
There is some early and real progress being made in international collaboration in clinical content by clinicians using openEHR

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Engaging Clinicians In Clinical Content

by Ocean Informatics on Sep 06, 2009

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